Abstract :
[en] For over 60 years, the Saskatoon Community Clinic (SCC) has stood out as an anomaly in Saskatchewan’s—and even Canada’s—health care system, delivering team-based, patient-centred services within a co-operative, patient-led governance model that contrasts with the physician-led clinics dominating primary care in the province. And for over 60 years, SCC’s leadership has argued that its approach to primary care offers better outcomes for both patients and taxpayers. In delivering holistic patient-centred care, the SCC may incur higher upfront costs, but this investment reduces downstream spending by reducing hospital emergency visits and admissions while avoiding the coordination costs of other clinics. Two earlier studies offered some support for this argument, showing that, from a cost perspective, SCC was both comparable to its physician-led counterparts (McPhee, 1973) and delivered net savings (Saskatchewan Health, 1983) to the province.
Since the publication of these studies, little research has revisited whether their findings still hold. In the meantime, SCC has evolved. Once operating from a single building on 2nd Avenue and serving a largely middle-class patient population, it now delivers care to 25% of its patients1 at its Westside clinic, which opened in 1975. This site primarily serves lower-income Indigenous patients facing complex health and social challenges that require a more responsive model of care.
The goal of this study was to better understand how the evolving SCC is performing in terms of patient outcomes, cost, and satisfaction. Our approach involved three distinct workstreams. The first workstream analyzed anonymized patient-level administrative data, including information on patient age and sex, medical visits and services, emergency visits, and hospitalizations. These data allowed us to revisit some of the questions addressed in the earlier empirical studies. After spending more than two years seeking approvals, we gained access to the data and assembled a detailed portrait of SCC’s patient population and the associated costs of their care from 2016 to 2021.
Compared with patients in other clinics, SCC patients experienced higher incidence rates across numerous disease categories, reported more chronic conditions, and made greater use of healthcare services. Although physician costs were generally lower, hospitalization costs for SCC patients were higher. These findings contrast with those of the 1983 study, which found that while SCC patient costs were higher, hospitalizations were less frequent. This shift may reflect the clinic's evolution—particularly its expansion to serve more diverse groups, including refugees, individuals experiencing homelessness, and those with substance use challenges.
In a more targeted quantitative exercise, we compared outcomes for HIV-positive individuals seen at SCC’s Westside clinic with those enrolled in the Saskatchewan Health Authority’s (SHA) Positive Living Program (PLP). The Westside clinic’s model of community-based opportunistic care appeared to foster stronger patient engagement than the PLP. However, an important caveat tempers this finding: although higher engagement is generally associated with improved viral suppression, this pattern did not hold for many Westside patients, who often face challenges such as substance use, transportation barriers, and housing insecurity. This discrepancy underlines two important points the SCC has long emphasized: (i) the clinic serves some of the hardest-to-reach populations in Saskatoon and (ii) health outcomes are shaped by a complex interplay of medical and non-medical factors, including access to transportation, housing, and drug treatment.
The second workstream surveyed patients about their primary healthcare experiences, seeking to understand whether SCC patients believed they had better, equal, or worse care experiences than non-SCC patients. Despite their generally poorer health, SCC patients expressed significantly higher satisfaction with their primary care than non-SCC patients. SCC patients felt more listened to, were more appreciative, and valued SCC’s coordinated, holistic care.
In the third workstream, we interviewed SCC staff (including medical practitioners), reviewed documentary evidence, and observed SCC’s governance practices to better understand the clinic’s inner operations—particularly how its model of care relates to its governance practices. If the SCC model differed from that of its counterparts, we would expect to see some evidence of that reflected in how decisions were made. We found that while decision-making was broadly team-based, there was room for improvement. Team-based care was constrained by resource limitations, workforce shortages, and persistent tensions between the team-based ideal and the formal and informal norms that reinforce physician power. We also noted concern—especially amongst longer-tenured staff and members—about the clinic’s co-operative identity. Some said the organization had drifted from its grassroots origins and become less responsive, raising questions about how these shifts may be affecting the team-based model.
Our findings suggest that SCC continues to play an indispensable role in the province’s primary care system, delivering services to a large, diverse patient population. This diversity is especially evident at the Westside clinic, which cares for patients who are often underserved—individuals whose complex needs make them less likely to be taken on by private physician-led clinics because of the time, cost, and coordination required.
